Abstract
Minimally invasive floating metatarsal osteotomy has been proposed as a surgical strategy to address recurrent or persistent diabetic foot ulcers (DFUs) by correcting underlying biomechanical deformities. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, querying four databases through September 2025 for studies involving adult patients with neuropathic DFUs treated with minimally invasive floating metatarsal osteotomy and followed for at least 12 months. Six studies comprising 184 subjects (176 with DFUs, 8 prophylactic) met inclusion criteria. Pooled outcomes demonstrated a healing rate of 98% (95% CI: 0.94-1.00) with a mean time to closure of 31.7 days (95% CI: 24.1-39.3). Ulcer recurrence occurred in 4% (95% CI: 0.02-0.09), while transfer lesions developed in 14% (95% CI: 0.08-0.20) and nonunion was observed in 14% (95% CI: 0.06-0.29). The overall infection rate was 7% (95% CI: 0.04-0.12). These findings indicate that minimally invasive floating metatarsal osteotomy is a safe and effective surgical option for off-loading neuropathic DFUs; demonstrating high healing rates, rapid time to closure and low recurrence when compared with conservative care. Larger randomised controlled trials are warranted to validate these results and establish standardised surgical indications.